Provider Demographics
NPI:1255420261
Name:LIEBERMAN, PAUL STANLEY (DPM)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:STANLEY
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6779 MEMPHIS AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BROOKLYN
Mailing Address - State:OH
Mailing Address - Zip Code:44144-2203
Mailing Address - Country:US
Mailing Address - Phone:216-351-3668
Mailing Address - Fax:216-351-4594
Practice Address - Street 1:6779 MEMPHIS AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:BROOKLYN
Practice Address - State:OH
Practice Address - Zip Code:44144-2203
Practice Address - Country:US
Practice Address - Phone:216-351-3668
Practice Address - Fax:216-351-4594
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2094213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT80533Medicare UPIN
OH1199800001Medicare NSC
OHLI0516914Medicare ID - Type Unspecified